Virginia Premier Health Plan, Inc.

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Sr. Manager, Quality - Dual Eligible Program and MLTSS

Sr. Manager, Quality - Dual Eligible Program and MLTSS

Job Locations 
US-VA-Glen Allen
Job ID 

Job Description


The Senior Manager, Quality -Dual Eligible Program and MLTSS supports the Director in all quality, regulatory and accreditation related activities. This includes, but is not limited to efforts associated with the National Committee for Quality Assurance (NCQA), Healthcare Effectiveness Data and Information Set (HEDIS), the Department of Medical Assistance Services (DMAS), the Centers for Medicare and Medicaid Services (CMS) and other required entities associated with or required by the state and/or federal government.  Additionally responsible for the quality oversight and management of the assigned line of business to include program development leadership and staffing. The core functions of this role focus on establishing quality performance initiatives impacting outcomes for the populations. This role assists in the identification and assessment of care gaps with resulting oversight and management related to quality strategies. This role works closely and collaboratively with various functional areas of the organization to achieve the goals and objectives of the Quality Program. Travel to regional offices is sometimes required.


  • Develop and implement the Quality Program for the appropriate lines of business.
  • Work with the Director and Executive Leadership to ensure all quality goals are met for the organization.
  • Work with the Director to plan, develop and monitor all Quality Improvement Programs and activities for the assigned line of business
  • Keeps abreast of new industry standards and best practices as it relates to population health outcomes and adjust accordingly
  • Oversight and management of quality teams, including day-to-day operations of staff across multiple regions.
  • Validates and ensures timely reporting to regulatory agency for Medical Record Review audits (MMR)
  • Cross collaboration across all business areas to develop quality initiatives to improve member outcomes
  • Develop, analyze, implement and support processes, policies, and standard operating procedures appropriate to meet organizational outcomes.
  • Development and implementation of a plan for on-going monitoring and enhancement of procedures and policies.
  • Works across business lines to define requirements for quality reporting for both internal and external entities
  • Conduct active problem identification and resolution to improve overall department efficiency and quality outcomes.
  • Participate in and provides leadership for organizational patient safety initiatives.
  • Educate organization on new and existing accreditation and regulatory requirements and conducts audits to ensure fulfilling accreditation requirements.
  • Work collaboratively with network providers/practitioners to execute the implementation of the clinical quality initiatives such as electronic medical record (EMR) data abstraction and transmission.





  • Bachelor’s degree in nursing or health care field
  • Registered Nurse licensed in Virginia 


  • Three (or more) years of clinical nursing experience
  • One (or more) year experience with regulatory reporting
  • Six Sigma/Lean Processing experience (highly preferred)
  • Strong organizational, analytical and interpersonal skills
  • Excellent training and presentation skills with solid communication capabilities and practices, both oral and written 


  • Proven leadership skills
  • Quality Improvement and/or Project Management design and implementation experience
  • Highly motivated individual with the ability to work independently
  • Must possess strong leadership capability, problem-solving and organizational skills, and the desire to foster good working rapport
  • Previous management experience, preferably leading teams in remote locations 


  • Physical health sufficient to meet the ergonomic standards and demands of the position.


About Us

Virginia Premier Health Plan, Inc. is a managed care organization which began as a full-service Medicaid MCO in 1995. Partnered with VCU Medical Systems we strive to meet the needs of the underserved and vulnerable populations in Virginia by delivering quality driven, culturally sensitive and financially viable Medicare and Medicaid healthcare programs.  Headquartered in Richmond, VA we also have offices in Roanoke, Tidewater and Bristol with additional satellite locations allowing us to serve over 200,000 members across eighty counties throughout Virginia. 


We offer competitive salaries and a comprehensive benefits package to include excellent Medical, Dental and Vision Plans, Tuition Assistance, Infant-At-Work Program, Remote Work options and generous vacation and sick leave policies. Our culture supports an environment where employees can continuously learn and gain professional growth through various development programs, education, exciting projects and career mobility.  


All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE


Our mission is to inspire healthy living within the communities we serve!

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